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Colitis associated with persistent drug-induced immune dysregulation
Johanna Köhler1,2, Randolf Hammerl3, Daniel M Mayer4
1Department of Clinical Pathology and Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden.
Two patients developed chronic colitis years after lymphoma treatment due to persistent immune dysregulation, not a specific drug or infection. This suggests a new category: immune dysregulation-associated colitis (ID-colitis).
Area of Science:
- Gastroenterology
- Oncology
- Immunology
Background:
- Adverse drug reactions commonly affect the gastrointestinal tract.
- Chemotherapy and autologous stem cell transplantation are used for lymphoma treatment.
Observation:
- Two cases of chronic colitis occurred months to years post-lymphoma therapy.
- Patients exhibited altered immune status (decreased CD4/CD8 ratio, hypogammaglobulinemia) without prior inflammatory bowel disease or immunodeficiency.
- Biopsies revealed chronic active colitis with architectural distortion, erosions, ulcers, and metaplasia.
Findings:
- Colitis was linked to lymphoma therapy but not a specific agent.
- Persistent immune dysregulation was identified as the likely driver of mucosal inflammation.
- Histopathological findings included chronic active inflammation and metaplasia.
Implications:
- Proposes "immune dysregulation-associated colitis" (ID-colitis) as a diagnostic term.
- Highlights the role of persistent immune dysfunction in late-onset colitis post-chemotherapy.
- Emphasizes the need to consider immune dysregulation in unexplained chronic colitis.
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